Individual
STEFANI TICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9200 CALUMET AVE # 203, MUNSTER, IN 46321-2885
(219) 228-4200
Mailing address
9200 CALUMET AVE # 203, MUNSTER, IN 46321-2885
(219) 228-4200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/17/2020
Last updated
02/14/2023
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